Why you should care

Women’s health still has a long way to go, but at least we’re not doing this anymore.

By Kristina Gaddy

The Daily DoseSEPT 25 2016

Around midnight on Dec. 18, 1885, Mrs. McK — her real name was left off historical records to maintain her privacy — started feeling pains. It was her third pregnancy in three years, and the two previous deliveries had required forceps, both resulting in the infant’s death.

The patient was a short, stout, powerful Irishwoman, and that winter night in Baltimore, she knew what to expect. She had access to the University of Maryland’s Free Lying-In Hospital and a number of other hospitals, but calling a midwife and delivering at home was still the most common practice. At around 10 a.m., the midwife manually broke Mrs. McK’s water in hopes of getting labor to progress. It didn’t, and a few hours later, two doctors arrived to try to deliver the baby with forceps. They tried, unsuccessfully, five times.

The problem with a Cesarean section in the pre-antibiotic era was that septic complications were still common.

James Drife, University of Leeds

Mrs McK remained alive, and in a great deal of pain. In the 19th century, women feared “going through labor and having babies not survive,” but the fear of dying themselves was also very real, says Carole McCann, chair of the women’s studies department at the University of Maryland, Baltimore County. It was unusual for women to not know someone who had died while giving birth.

A full day into the ordeal, Mrs. McK’s life was in danger. The baby was stuck, and if the doctors couldn’t manage to remove it, Mrs. McK would die. In 1876, Eduardo Porro performed the first successful operation to extract a baby through an incision in the uterus and have both mother and babe survive. His improved Cesarean section — variations had been around for centuries, usually employed to try to save the baby after a mother died during childbirth — was a breakthrough that enabled doctors to save both mother’s and baby’s lives. But by 1885, the procedure was still not common practice. “The problem with a Cesarean section in the pre-antibiotic era was that septic complications were still common,” says James Drife, professor emeritus of obstetrics and gynecology at the University of Leeds. A C-section could not be performed at home, and even in a hospital, infections were not easy to treat.

So around midnight on the 19th, a day after the midwife broke Mrs. McK’s water, L.E. Neale of the Free Lying-In Hospital arrived. His immediate concern was saving Mrs. McK’s life. He knew the baby had not survived and decided that the best hope for Mrs. McK’s survival, and the baby’s extraction, was a craniotomy. To perform the procedure, Neale had Mrs. McK — who remained conscious, and unaided by pain relief — lie on the edge of the bed, her legs raised in the air.

Neale then used a cranioclast, a device that looks downright medieval, to begin removing the baby. At one end is the handle; at the other is what resembles forceps spoons: two metal pieces fitted together, one elongated and open in the middle, the other sitting snugly inside when a wing nut and vise are screwed together. When the two metal pieces clamp, they crush anything they come into contact with. Neale reported to colleagues that he had torn “away piecemeal” at the baby’s skull bones for an hour and a half and that it took a full three hours to fully extract the baby.

Throughout the ordeal, Mrs. McK proved resilient, and four days later, just in time for Christmas, she was up and out of bed. Two years later, in 1887, Neale was called again to Mrs. McK’s. Her labor had stalled, and the physician had no choice but to perform another craniotomy, this time with chloroform. Neale later gave a presentation to the Medical and Chirurgical Faculty of the State of Maryland explaining how the Cesarean section could give hope to women suffering from pelvic abnormalities or difficult labors, like Mrs. McK. Records show that by 1888, he was successfully delivering babies by C-section.

Today, one-third of American babies are delivered via C-section, both for elective and medical reasons. And while one doctor wrote in 1920 that “the horrible, brutal means of extracting the child seem today as if they should hark back to the very darkest of all ages,” so-called destructive operations like the craniotomy are still used today — particularly in poor, rural areas of developing countries where access to C-sections remains limited, and the procedure unsafe. Barbaric? Sure, but sometimes it’s still the best way to save a mother’s life.